Case of deadly yeast infection confirmed in Oakland County

Karen Bouffard
The Detroit News

A deadly, medication-resistant fungal infection has been identified in Oakland County, according to state medical authorities. 

The state laboratory in Lansing confirmed the fungus, Candida auris, in a culture collected from ear drainage from a 76-year-old man on May 27. The case was not made public at the time. 

A strain of Candida auris cultured in a petri dish at a CDC laboratory.

The case was flagged by the Documenting COVID-19 project at Columbia University's Brown Institute for Media Innovation, which obtained a copy of an alert issued to local public health departments, hospitals and other agencies by the Michigan Health Alert Network. The case was first reported Thursday by the Detroit Free Press.

The man was identified as having a history of chronic ear infections and had not traveled outside the United States for three years, according to the alert from the Michigan Health Alert Network. No other details about the case were made available.

Spread of the fungus is not related to the pandemic, said Derek Kravitz, project leader for Documenting COVID-19. The project has been tracking Candida auris due to the public interest in knowing about the deadly infection. 

Efforts to reach Dr. Russell Faust, medical director for the Oakland County Health Division, were unsuccessful. Spokeswoman Kathy Gray confirmed a case had been identified in the county. 

"We generally do think that public health information that could lead to awareness about ongoing infection or spread of various illnesses .. .or fungal infections in this case, is important for pubic health," Kravitz said. 

"Typically what we've seen with important public heath information like, say, COVID-19, is that local or state health departments release that information in press release form so that media and the public are aware." 

State health department spokeswoman Lynn Sutfin said the Michigan Department of Health and Human Services sent a Health Alert Network notice to local health departments, labs, epidemiologists and health care partners about the case.

"This was the first case identified in Michigan," Sutfin said in an email late Thursday. "There was no threat to the public, and the patient’s health care providers were aware and took the proper precautions. There have not been additional cases identified at this time."

Candida auris, or C. auris, is a yeast that may cause serious illness or invasive infections, such as bloodstream infections, that can result in death, particularly in hospital and long-term care patients, according to the notice sent by the Michigan Health Alert Network to local health agencies.

The fungus is a threat because it is often multidrug-resistant. It can be difficult to identify and can live on surfaces in health care environments. 

More than 1 in 3 patients with an invasive infection die, according to the Centers for Disease Control and Prevention.

The multidrug- or pan-resistant yeast first was identified in Japan in 2009 and arrived in the United States in 2016, according to the CDC. It has been spreading slowly in health care facilities since then, mostly in immune-compromised patients. 

The CDC in mid-July disclosed in the publication Morbidity and Mortality Weekly Reports that it had identified two clusters of C. auris from January through June of this year, one involving three patients at a Washington, D.C., nursing home, and another including seven patients at where two hospitals in Texas.  

The combined 30-day mortality from the two outbreaks was 30%, although whether those deaths were caused by C auris is unclear, according to the CDC's report.

While many C. auris cases have been resistant to azoles and polyenes, two of the three major classes of antifungals used to treat Candida infections, the clusters stood out to the CDC's attention because all 10 cases in the two clusters also were resistant to echinocandins, the first-line treatment for invasive C. auris infections.

According to the CDC, unlike other types of yeast, which tend to colonize in the gut, C. auris colonizes on the skin — making it easy to transfer to other people from bed rails and other surfaces in a hospital environment. 

The yeast can spread between facilities within health care networks when colonized or infected patients are transferred. 

"It makes the containment really challenging, because you can't just focus on one facility," the CDC's Dr. Meghan Lyman wrote in the MMWR article. "When you find it in a facility, it may just be the tip of the iceberg, and there are a lot of other cases that may have gone undetected."